From the Guidelines
Tranexamic Acid (TXA) is not recommended as a primary treatment to stop gastrointestinal bleeding, as the evidence for its effectiveness in this setting is limited and inconclusive 1.
Mechanism of Action and Potential Benefits
TXA works by inhibiting the breakdown of fibrin clots, which could potentially be beneficial in stopping a gastrointestinal (GI) bleed. However, the use of TXA in GI bleeding may be limited by its potential to increase the risk of thromboembolic events, particularly in patients with underlying cardiovascular disease.
Evidence from Clinical Guidelines
The European Association for the Study of the Liver (EASL) clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis recommend against the use of TXA in patients with cirrhosis and active variceal bleeding 1. Additionally, the guidelines suggest that TXA should not be used in patients with cirrhosis undergoing invasive procedures to decrease the rate of procedure-related clinically relevant bleeding 1.
Specific Patient Populations
In patients with hereditary hemorrhagic telangiectasia (HHT), TXA may be recommended for mild GI bleeding due to its low potential for harm, but there is limited evidence of effectiveness 1. In critically ill adults, further research is required to evaluate the role of TXA in gastrointestinal bleeding 1.
Key Points
- TXA is not recommended as a primary treatment to stop gastrointestinal bleeding
- The evidence for TXA's effectiveness in GI bleeding is limited and inconclusive
- TXA may increase the risk of thromboembolic events, particularly in patients with underlying cardiovascular disease
- Clinical guidelines recommend against the use of TXA in patients with cirrhosis and active variceal bleeding, as well as in patients with cirrhosis undergoing invasive procedures.
From the FDA Drug Label
Gastrointestinal Bleeding and Tranexamic Acid
Tranexamic Acid (TXA) is used for various medical conditions, but its primary use is to prevent or treat excessive blood loss from major trauma, postpartum bleeding, surgery, tooth removal, nosebleeds, and heavy menstruation 2.
Mechanism of Action
TXA works by inhibiting the breakdown of fibrin clots, which are essential for stopping bleeding. However, the provided FDA Drug Label does not directly address the use of TXA for gastrointestinal bleeding.
Overdosage Symptoms
According to the FDA Drug Label 2, symptoms of TXA overdosage may include gastrointestinal issues such as:
- Nausea
- Vomiting
- Diarrhea
These symptoms suggest that while TXA may be associated with gastrointestinal side effects, the label does not provide information on its use for stopping gastrointestinal bleeding. There is no direct evidence from the provided FDA Drug Label to support the use of TXA for this specific condition 2.
From the Research
Efficacy of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been studied for its potential to stop gastrointestinal bleeding, with evidence suggesting it may be effective in reducing mortality and bleeding rates 3, 4, 5, 6, 7.
- A 2012 systematic review found that TXA reduced mortality compared to placebo in patients with upper gastrointestinal bleeding, although the beneficial effect was not confirmed in subgroup analyses 3.
- A 2021 systematic review and meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo in patients with upper gastrointestinal bleeding 4.
- Another study published in 2015 found that TXA probably decreases rebleeding and mortality without increasing thromboembolic adverse effects in patients with upper gastrointestinal bleeding 5.
- A 2020 systematic review and meta-analysis found that TXA was superior to placebo in reducing mortality in patients with upper gastrointestinal bleeding, with moderate-quality evidence supporting its use 6.
- An earlier systematic review published in 2008 also suggested that TXA may reduce all-cause mortality in patients with upper gastrointestinal bleeding, although additional evidence was needed to confirm this finding 7.
Mechanism of Action and Safety
- TXA works by reducing haemorrhage through its antifibrinolytic effects, which may help to stabilize patients before endoscopic treatments 3, 4.
- The safety of TXA in patients with gastrointestinal bleeding has been evaluated, with some studies finding no significant increase in thromboembolic events 3, 5, 6.
- However, the risk of adverse events, including thromboembolic disease, should be carefully considered when using TXA in patients with gastrointestinal bleeding 3, 7.
Clinical Implications
- The available evidence suggests that TXA may be a useful adjunctive treatment for patients with upper gastrointestinal bleeding, particularly in reducing mortality and bleeding rates 4, 6.
- However, the quality of the evidence varies, and additional higher-quality trials are needed to confirm the efficacy and safety of TXA in this setting 3, 6, 7.
- Clinicians should carefully consider the potential benefits and risks of TXA when deciding whether to use it in patients with gastrointestinal bleeding, and should be aware of the latest evidence and guidelines on its use 4, 6.